I have used it for some patients with "migraine"/cervicogenic headache, SUNCT syndrome, cluster patients, and those with atypical orbital/facial pain. We don't charge anything for placing lidocaine up someone's nose with a q-tip. If it relieves the pain, we will arrange for the patient to self administer maximally 2X per week. You want to use the device that instills lidocaine into the urethra prior to urological procedures. We used to use a 4% lidocaine bottle with a soft extension tube (kind of like WD-40), but I don't think they make it anymore. Sticking Q-tips up the nose often can result in nasal mucosal trauma/bleeds- you need a soft applicator.
Billing for a spehnopalantine block with topical local is fraud. It's just local in the nose, after all.
I have had good luck with sphenopalantine rf for those who would otherwise need to use the lidocaine more frequently, or those with cluster headaches. Our cluster patients get that done every 1-1.5 years. It is kind of fun to do, as it scares some providers. You have to make sure the probe goes posterior enough, otherwise you burn the superior palantine nerves and get a numb palate. Don't think too hard about where you are at anatomically (like when you do trigeminal rf) and it is easier to do.
Interestingly, one of the coolest seizures I have ever seen was at the hands of one my former partners doing a trigeminal rf. I taught him the procedure and emphasized never, never put local through the needle. You ramp up the temps slowly so it doesn't hurt so much. He put in local to be "nice" and it was very interesting!